Laurie Gillard

Currently we use an R number, as well as the name and MRN. We treat pre-op patients as we do our inpatients and outpatients. The thing is, the patient is drawn in pre-op. The band is put in the patient's chart. When the patient is admitted, he/she gets banded at that time. What bothers me is, the person who drew the initial sample isn't necessarily the same person who will band the patient when the patient returns. This is part of the reason I'm not a big fan of a 3rd identifier, or at least a separate bb identifier. I think you can use the DOB as a third identifier if you really feel you need one. I also would like to propose involving the patient (as long as the patient is conscious) by having them say their name and give their birth date. In addition to checking the wrist band, you can add the patient's response as another safety check in the transfusion process. I also think (I'm on a roll now!) getting the patient to participate is important from the patient stand point, they can free confident that the phlebotomist/transfusionist is being extra careful with their medical treatment.

What are your feelings about using a unique indentifier (in our case, "R" number) for blood bank specimens? The Standards require 2 unique identifiers and the Joint Commission (in a 1999 article) recommended a third identifier but in the 2007 Patient Safety Goals (Requirement 1A) recommends using two identifiers when administering blood products...I'm in the middle of proposing improvements in blood collection policies, frankly I don't feel a third identifier is necessary as long as the patient is properly indentified at the bedside and the specimen is collected and label in the presence of the patient. I would appreciate any thoughts on this issue. Thanks.

Our blood bank is currently in the process of making the switch to "frozen plasma" from FFP (obviously, less than 24 hours)...FFP is not the treatment of choice for a Factor 8 deficiency, you get the concentrates from the pharmacy, but we are going to put a comment for the physicians who order plasma to call the medical director if the patient is being treated for a Factor 5 deficiency (which is very rare). The big incentive for us is the availability of plasma for our trauma patients. We haven't decided if we'll take the expiration date of the plasma out to 5 days...from the sounds of the other postings, a 5 day expiration appears to be the standard practice.